阿托伐他汀联合普罗布考改善对比剂急性肾损伤的临床观察  

Combined Effect of Atorvastatin and Probucol on Contrast-induced Acute Kidney Injury

作　　者：王一然[1] 李曦铭[2] 张迎怡[2] 李作成[2] 肖健勇[2] 丛洪良[2] 

机构地区：[1]天津医科大学研究生院,300070 [2]天津市胸科医院心内四科

出　　处：《天津医药》2011年第1期31-34,共4页Tianjin Medical Journal

基　　金：天津卫生局攻关课题(项目编号:10KG122)

摘　　要：目的:观察术前联用不同剂量阿托伐他汀与普罗布考对对比剂急性肾损伤(CIAKI)的影响。方法:149例接受择期冠状动脉造影(CAG)或经皮冠状动脉支架植入术(PCI)的冠心病患者,随机分为标准剂量组46例,阿托伐他汀每晚顿服20mg及普罗布考250mg,3次/d;强化联合组47例,阿托伐他汀每晚顿服40mg及普罗布考250mg,3次/d,术前2h顿服阿托伐他汀40mg普罗布考500mg;强化剂量组56例,阿托伐他汀每晚顿服40mg,术前2h顿服阿托伐他汀40mg。所有患者均于术前和术后24h抽取静脉血检测尿素氮(BUN)、肌酐(Scr)、肾素全项,MDRD方法估算肾小球滤过率(eGFR)。结果:(1)与术前比较,标准剂量组术后Scr升高,eGFR下降,AngⅡ升高(P<0.05);强化联合组术后BUN和AngⅡ下降,强化剂量组术后BUN下降(P<0.05或P<0.01),Scr及eGFR差异无统计学意义。(2)强化联合组Scr下降值(△Scr)及△AngⅡ高于标准剂量组(P<0.05)。(3)对于肾功能轻中度损伤患者,强化联合组△Scr和△BUN高于其他2组(P<0.05)。结论:阿托伐他汀联合普罗布考强化或单用阿托伐他汀强化均可改善CIAKI,对于肾功能轻中度损伤患者,强化联合治疗改善作用显著。Objective：To observe the effects of different doses of atorvastatin combined with probucol on contrast-induced acute kidney injury （CIAKI）before coronary angiography（CAG） or percutaneous coronary intervention（PCI）. Methods： One hundred and forty-nine cases were randomly divided into 3 groups, standard combined treatment group （n = 46, atorvastatin 20 mg/d,1 time/d and probucol 250 mg/d,3 times/d; intensively combined treatment group （n = 47, atorvastatin 40 mg/d,1 time/d,and probucol 250 mg/d,3 times/d, intaking bolus of atorvastatin 40 mg/d,1 time/d and probucol 500 mg 2 hours before intervention; intensive atorvastatin therapy group （n = 56, atorvastatin 40 d,1 time/d, bolus intaking atorvastatin 40 mg 2 hours before procedure. The values of urea nitrogen （BUN）, serum creatinine （Scr）, and all items rennin were detected before angioplasty and 24 h after angioplasty in patients of 3 groups. The level of glomerular filtration rate （eGFR） was estimated using the MDRD formula. Results： （1） After angioplasty,the levels of Scr and AngⅡ increased significantly,but eGFR decreased significantly in standard combined treatment group（P 0.05）. The levels of BUN and AngⅡ decreased remarkably in intensively combined treatment group after angioplasty（P 0.05 or P 0.01）, while no significant difference in values of Scr and eGFR. （2）The values of △Scr and △AngⅡ were higher in intensively combined treatment group than those of standard combined treatment group（P 0.05）.（3）For the patients of mild to moderate renal function, the values of △Scr and △BUN were significantly higher in intensively combined treatment group than those of the other two groups（P 0.05）. Conclusion： The combination of atorvastatin 40 mg and probucol 250 mg or atorvastatin 40 mg before angiography could improve CIAKI. For the patients of mild to moderate renal function, strengthen and combined treatment could improve significantly.

关 键 词：冠状血管造影术 血管成形术 经腔 经皮冠状动脉 造影剂 肾疾病 普罗布考 阿托伐他汀 

分 类 号：R589.2[医药卫生—内分泌]